The LBJ hospital in American Samoa is running into understaffing problems.
According to the chief Financial Officer David Deprin a recent inspection of the hospital by a federal agency, noted deficiency with staffing in certain areas.
Mr Deprin said the hospital had lost 43 of its 600 employees in the last year.
The reduction has mostly been through attrition.
Mr Deprin said the hospital needed to hire more lab and pharmacy staff to meet eligibility requirements for the Medicaid and Medicare programmes.
More than 50 jobs had been identified by hospital management to be released by this month as part of the LBJ's cost cutting plan but Mr Deprin indicated that their preference was to eliminate through attrition.
The hospital is stepping up collection of unpaid hospital bills and has begun sending out astatements for the first time.
Mr Deprin said outstanding patient bills total more than US$700,000.